Provider Demographics
NPI:1528312261
Name:GRAF, MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:GRAF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SHOPKO DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4074
Mailing Address - Country:US
Mailing Address - Phone:608-249-6919
Mailing Address - Fax:
Practice Address - Street 1:2602 SHOPKO DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4074
Practice Address - Country:US
Practice Address - Phone:608-249-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist